Advanced Cirrhosis

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What is Advanced Cirrhosis?

Advanced cirrhosis is the late stage of chronic liver disease in which healthy liver tissue is replaced with extensive scar tissue (fibrosis), causing permanent damage and loss of liver function. The scarring blocks blood flow through the liver and disrupts its ability to process nutrients, hormones, drugs, and toxins.

Cirrhosis can result from many chronic liver conditions, including chronic hepatitis B or C, alcoholic liver disease, nonalcoholic steatohepatitis (NASH), autoimmune hepatitis, or genetic liver disorders. When cirrhosis progresses to an advanced stage, it can lead to serious, life-threatening complications such as liver failure, internal bleeding, and liver cancer.

Is Advanced Cirrhosis common?

Cirrhosis affects millions of people worldwide and is a leading cause of liver-related deaths. Advanced stages are often seen in individuals with long-term alcohol misuse, untreated viral hepatitis, or metabolic liver diseases. Because early cirrhosis may not cause symptoms, many patients are diagnosed only when the disease has significantly progressed.

Can Advanced Cirrhosis be cured?

The scarring in advanced cirrhosis is irreversible, but early detection and proper treatment can slow or halt further liver damage and manage complications. In severe cases, a liver transplant may be the only curative option.

Causes

What causes Advanced Cirrhosis?

Cirrhosis represents the end result of chronic liver injury from a variety of causes:

  • Chronic alcohol abuse
  • Viral hepatitis B or C
  • Nonalcoholic steatohepatitis (NASH)
  • Autoimmune hepatitis
  • Primary biliary cholangitis (PBC) or primary sclerosing cholangitis (PSC)
  • Genetic/metabolic disorders: hemochromatosis (iron overload), Wilson’s disease (copper buildup), alpha-1 antitrypsin deficiency
  • Long-term exposure to toxins or certain medications

With Insurance

Hepatology

Your copay
Depending on insurance

Without Insurance

*Price Effective 12/1/2025
$125
Initial Visit
$95
Follow Up

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Symptoms

What are the symptoms of Advanced Cirrhosis?

Early cirrhosis may cause few or no symptoms, but advanced cirrhosis often leads to multiple complications:

General symptoms:

  • Persistent fatigue and weakness
  • Loss of appetite and weight loss
  • Nausea or abdominal discomfort
  • Jaundice (yellowing of skin and eyes)

Complications of advanced cirrhosis:

  • Ascites: fluid buildup in the abdomen
  • Edema: swelling in legs and ankles
  • Variceal bleeding: internal bleeding from enlarged veins in the esophagus or stomach
  • Hepatic encephalopathy: confusion, memory problems, or disorientation due to toxin buildup
  • Easy bruising and bleeding: due to decreased clotting factor production
  • Spider angiomas: small, visible blood vessels on the skin
  • Muscle wasting and malnutrition
  • Dark urine, pale stools

Diagnosis

How is Advanced Cirrhosis diagnosed?

Diagnosis typically involves a combination of clinical evaluation, lab tests, and imaging studies:

  • Medical history and physical exam – looking for risk factors and physical signs such as jaundice or ascites
  • Blood tests – assess liver function (ALT, AST, bilirubin, albumin, INR) and platelet count
  • Imaging – ultrasound, CT scan, or MRI to detect scarring, nodules, or portal hypertension
  • FibroScan (elastography) – measures liver stiffness to assess the degree of fibrosis
  • Endoscopy – to detect varices (enlarged veins) in the esophagus or stomach
  • Liver biopsy – occasionally used to confirm diagnosis or determine cause

Alpha-fetoprotein (AFP) test – monitors for liver cancer (hepatocellular carcinoma)

Treatment

How is Advanced Cirrhosis treated?

While scarring from cirrhosis cannot be reversed, treatment focuses on slowing progression, preventing complications, and managing symptoms.

Lifestyle and general measures:

  • Complete abstinence from alcohol
  • Healthy diet: Nutritional support: a balanced, protein-rich, vitamin-rich diet (especially B-complex, folate, thiamine), adjusted based on your hepatologist’s guidance.
  • Avoiding unnecessary medications or toxins that affect the liver
  • Vaccinations: hepatitis A and B, flu, and pneumonia vaccines

Medications and management of complications:

  • Diuretics (spironolactone, furosemide) – reduce fluid buildup (ascites, edema)
  • Beta-blockers (propranolol, nadolol) – prevent variceal bleeding
  • Lactulose or rifaximin – treat hepatic encephalopathy
  • Antivirals or immunosuppressants – if caused by hepatitis or autoimmune disease
  • Antibiotics – prevent infections common in cirrhosis (e.g., spontaneous bacterial peritonitis)

Procedures:

  • Paracentesis – draining fluid from the abdomen in severe ascites
  • Endoscopic banding – for bleeding varices
  • TIPS (Transjugular Intrahepatic Portosystemic Shunt) – relieves portal hypertension

Liver transplantation – definitive treatment for liver failure or decompensated cirrhosis

References

Medically reviewed by:

Dr. Javeed Siddiqui, MD, MPH

Dr. Siddiqui is the Chief Medical Officer at TeleMed2U responsible for clinical and technical program development as well as maintaining a thriving telemedicine practice in infectious diseases which includes specialized care of Hepatitis and HIV.

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With Insurance

Hepatology

Your copay
Depending on insurance

Without Insurance

*Price Effective 12/1/2025
$125
Initial Visit
$95
Follow Up

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